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Tibialis posterior tendon repair - flatfoot deformity, addressed properly.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private tibialis posterior surgery costs in the UK.

Indicative ranges from our foot and ankle network.

In short

FDL transfer + calcaneal osteotomy: £11,000–£17,000, home 1–2 nights.

ProcedureIndicative range
Tenosynovectomy and debridement of tibialis posterior £4,500–£7,500
FDL tendon transfer alone £7,500–£12,000
FDL transfer + medialising calcaneal osteotomy £11,000–£17,000
Full flexible flatfoot reconstruction (soft tissue + osteotomies) £14,000–£22,000
Triple arthrodesis for rigid deformity £16,000–£26,000
Weight-bearing CT and MRI package £850–£1,400
Consultant foot and ankle consultation £280–£450

Prices vary by surgeon, by the combination of bony and soft-tissue procedures, and by whether a fusion is added. Metalwork and imaging are usually included in the quote.

The problem

The right operation depends on the stage.

Modern foot and ankle practice matches procedures to the Deland/PCFD stage. Under-doing a stage-II foot leaves symptoms; over-doing a stage-I foot commits it to unnecessary fusions.

  • Stage first, cut second

    Weight-bearing imaging and a clinical assessment come before the theatre list.

  • Combined procedures beat isolated ones

    For stage II, FDL transfer plus calcaneal osteotomy beats either alone.

  • Preserve joints where you can

    Fusion is reserved for rigid deformity or established arthritis - not for early flexible cases.

The journey

From symptoms to recovery - what happens, in order.

One consultant sees you from imaging and orthotic trial through surgery, boot and physiotherapy.

  1. 01

    Before

    Medial ankle pain, arch collapse, difficulty on heel raise, previous injuries, hindfoot pain, footwear tried, weight and activity level.

  2. 02

    Before

  3. 03

    Before

    Weight-bearing X-rays and MRI

    Standing X-rays of the foot and ankle, weight-bearing CT where available, MRI to assess the tibialis posterior tendon, spring ligament and any subtalar arthritis.

  4. 04

    Before

    Trial of orthotics and physiotherapy

    Most stage I and early stage II cases deserve a proper trial of custom orthotics, tendon-strengthening physiotherapy and weight optimisation for at least 3 months before surgery.

  5. 05

    On the day

    Surgery in theatre

    General anaesthetic with regional block. Tendon debridement, FDL tendon transfer to the navicular, medialising calcaneal osteotomy and spring-ligament reconstruction - combined per stage. Two to four hours.

  6. 06

    On the day

    Overnight or same-day

    Day-case for isolated tendon procedures. One to two nights for bony work. Cast or boot, non-weight-bearing for 4–6 weeks.

  7. 07

    After

    Rehabilitation and return

    Boot for 4–6 weeks, then progressive weight-bearing. Physiotherapy weekly for the first three months. Return to office work at 6–8 weeks, sport at 6–9 months.

Typical end-to-end: 4–6 weeks from first appointment to surgery. Sport is realistic at 6–9 months.

When it helps

When tibialis posterior repair is the right step.

The staging patterns we see most, plus the red flag that means A&E, not a foot clinic.

  • Stage I - inflamed tendon, no deformity

    Medial ankle pain, tenderness along the tibialis posterior, but the arch is preserved. Orthotics, physiotherapy and, if needed, tendon debridement.

  • Stage II (flexible) - arch collapse

    The tendon is elongated or torn, the arch has fallen but is still correctable by hand. FDL transfer and calcaneal osteotomy is the modern default.

  • Stage III (rigid) deformity

    The hindfoot no longer moves and osteoarthritis has set in. Triple arthrodesis (talonavicular, subtalar, calcaneocuboid fusion) restores alignment.

  • Stage IV - ankle valgus deformity

    The talus has tilted at the ankle joint. Adds tibiotalar realignment or fusion to the reconstruction - often a complex ankle case.

  • Acute tendon rupture

    Sudden pain and inability to heel-raise on one foot. Early repair or reconstruction gives the best chance of preserving hindfoot function.

  • Post-traumatic flatfoot

    Following ankle fracture, subtalar injury or ligament rupture - the reconstruction is tailored around the previous fixation.

  • Inflammatory arthropathy

    Rheumatoid, psoriatic and other inflammatory arthropathies erode the tibialis posterior. Surgery is coordinated with the rheumatology team.

  • Red flag: acute foot with red hot skin and systemic upset

    Fever, spreading redness and severe foot pain with recent injury is possible septic arthritis or necrotising infection - A&E today, not a foot clinic.

Procedure options

Every option - from debridement to triple arthrodesis.

  • Tenosynovectomy and debridement

    Removal of inflamed tenosynovium and any degenerate tendon fibres. For stage I disease that has failed conservative care.

  • FDL tendon transfer

    The flexor digitorum longus tendon is rerouted and attached to the navicular to substitute for the failing tibialis posterior. The workhorse soft-tissue procedure.

  • Medialising calcaneal osteotomy

    The heel bone is cut and shifted medially to move the load line back under the ankle. Almost always combined with FDL transfer in stage II disease.

  • Spring-ligament reconstruction

    Repair or reconstruction of the plantar calcaneonavicular (spring) ligament - a key contributor to arch stability, often torn alongside the tibialis posterior.

  • Lateral column lengthening

    An Evans osteotomy of the anterior calcaneus corrects forefoot abduction in more severe flexible deformities.

  • Cotton osteotomy (medial cuneiform)

    Corrects forefoot supination and restores tripod loading. A useful adjunct in many stage II reconstructions.

  • Triple arthrodesis

    Fusion of talonavicular, subtalar and calcaneocuboid joints. Reserved for rigid stage III deformity or established hindfoot arthritis.

  • Non-operative management

    Custom orthotics, boot brace, tendon-strengthening physiotherapy, weight loss and activity modification - always the first step for flexible early disease.

Safety and recovery

What to expect afterwards - honestly.

Reconstructive foot surgery is a long recovery, but with well-selected staging and physiotherapy the outcomes are reliable.

  • GA with a regional block

    General anaesthesia combined with a popliteal or ankle block gives excellent analgesia for the first 12–18 hours.

  • Wound and infection risk

    Superficial wound problems in around 3–5%, deep infection under 1%. Smoking and diabetes push these rates up - we address both before surgery.

  • Non-union of osteotomies

    Calcaneal osteotomies unite reliably in non-smokers (over 95%). Smoking, poorly controlled diabetes and vitamin D deficiency raise non-union risk.

  • Nerve irritation

    Sural or medial calcaneal nerve irritation is uncommon but real, particularly after calcaneal osteotomies. Usually settles within 3–6 months.

  • Under- or over-correction

    Getting the shape right takes intra-operative fluoroscopy and experienced judgement. Under-correction leaves symptoms; over-correction causes lateral pain.

  • DVT and PE

    Foot and ankle surgery carries a real DVT risk, especially with a non-weight-bearing cast. Prophylaxis is standard; early mobilisation matters.

  • Recovery is long

    Six weeks non-weight-bearing, then a further six weeks in a boot. Sport is realistic at 6–9 months, sometimes longer for pivoting sports.

  • Progression risk

    Even excellent surgery does not stop underlying tendon disease indefinitely. Weight, footwear and ongoing physiotherapy remain important.

  • Red flags after surgery

    Calf pain and swelling, breathlessness, spreading redness, fever, or a cast that feels too tight - same-day call to the surgical team or A&E.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever combination was done, the note the foot and ankle surgeon sends you keeps to the same shape.

A UK consultant foot and ankle surgeon reviewing weight-bearing CT

A quiet reminder

Medical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note and the imaging before your review, just ask.

  1. 01Header

    Deformity stage and procedures done

    Deland/PCFD stage, tendon findings, and each soft-tissue and bony procedure performed with metalwork used.

  2. 02Technique

    Osteotomy positions and fixation

    The size and position of any calcaneal, lateral column or Cotton osteotomies, and the screws or plates holding them.

  3. 03Findings

    Tendon and ligament quality

    State of the tibialis posterior, spring ligament and deltoid - the honest degree of degeneration found at surgery.

  4. 04Impression

    Weight-bearing and rehab plan

    Read this first: non-weight-bearing period, boot progression, physiotherapy schedule and expected return to work and sport.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Tibialis posterior tendon reconstruction is usually covered when clinically indicated.

Frequently asked

Everything we get asked about tibialis posterior tendon repair.

Quick answers on staging, FDL transfer, recovery time and cost.

  • How do I know if my flatfoot needs surgery?

    Signs that push a foot from ‘manage with orthotics’ to ‘consider surgery’ are: progressive medial pain, difficulty performing a single-leg heel raise, visible collapse of the arch when standing, and pain that is not controlled by three months of custom orthotics and specialist physiotherapy. A foot and ankle consultant with weight-bearing X-rays and MRI makes the call.

  • What is FDL transfer and why is it needed?

    The tibialis posterior tendon is often too damaged to repair directly. The FDL (flexor digitorum longus) tendon runs immediately alongside it, is expendable in most feet, and can be rerouted and attached to the navicular to take over the role of the tibialis posterior. It works reliably in stage II disease when combined with a calcaneal osteotomy.

  • How long am I off my foot after surgery?

    Typically six weeks non-weight-bearing in a cast or boot, then a further four to six weeks in a walking boot with progressive weight-bearing. Office work returns at 6–8 weeks, driving at 8–12 weeks, and sport at 6–9 months depending on how much bony work was needed.

  • Will I need my joints fused?

    Only if the deformity is rigid, or if arthritis is already established in the hindfoot joints. Flexible flatfoot (stage II) is corrected without fusion in most cases - the whole point of tendon transfer and osteotomy is to preserve the joints.

  • How much does private tibialis posterior surgery cost in the UK?

    Roughly £4,500–£7,500 for tenosynovectomy alone, £7,500–£12,000 for FDL transfer alone, £11,000–£17,000 for FDL transfer plus calcaneal osteotomy, and £14,000–£22,000 for a full flexible flatfoot reconstruction. Triple arthrodesis for rigid deformity is £16,000–£26,000. Firm figures are back in one working day.

  • Can I have this on the NHS?

    Yes - the NHS treats tibialis posterior tendon dysfunction routinely, with the same techniques. Waits for imaging and theatre are longer in most regions, which is why patients look privately - but there is nothing exotic about the surgery itself.

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